ASHAs (accredited social health activist) leadership role in delivering diabetic care services to urban poor during COVID-19 in Hyderabad, India.

Purpose: This study aims to explore the role of female frontline community health workers, accredited social health activists (ASHAs), in delivering health care to urban poor living with Type 2 diabetes mellitus (T2DM) in two urban slums in Hyderabad, India. The study describes the additional challenges faced by them during the COVID-19 period and their leadership role in delivering care services to people with diabetes during COVID-19.

Design/methodology/approach: Research methods comprise semi-structured in-depth interviews and focus group discussions with ASHAs, individuals with T2DM, and community leaders from August 2021 to July 2023. The study tools were developed based on framework of the Explanatory Model Interview Catalogue. Data were analysed using thematic analysis.

Findings: The analysis revealed three main themes, describing challenges faced by ASHAs in COVID-19 management- overburdening of ASHAs, unsafe working conditions and social stigma in communities; COVID-19 impact on people with diabetes mellitus; and leadership demonstrated by ASHAs.

Practical implications: The pandemic served as a critical event that foregrounded the role of ASHAs as crucial in mitigating the impacts of the disease, resulting in increasing trust between ASHAs and impacted communities. The results, thus, highlight a potential opportunity to enable and support ASHAs better to improve the reach of primary health-care services in India overall.

Originality/value: Research study is original. This research reveals vital role of ASHAs leadership in the context of health-care delivery and contributing to the battle fighting against pandemic while rendering services in the socially disadvantaged communities during COVID-19 pandemic.